6 tips for dealing with medical gaslighting, according to doctors

• Medical gaslighting is when clinicians make patients believe their symptoms are all in their heads.

• It can lead to delayed diagnoses and improper treatment, but there are strategies to deal with it.

• Doctors told Insider preparation, communication, and a little understanding can go a long way.

At age 43, Paula Chambers Raney started experiencing diarrhea, painful gas, and stomach gurgling after meals. But doctors told her it was probably a stomach bug, or acid reflux, or irritable bowel syndrome.

Even when Raney tested extremely low for iron and was too exhausted to make it through the workday, she said doctors told her it was probably her diet or menstrual cycle. And when she reported blood in her stools, they told her she'd likely just eaten something red.

After about a year with no answers, Raney had lost 40 pounds and was in the worst pain of her life. "By now, most folks aren't listening to me. Most folks think I'm crazy. Most folks think I'm a hypochondriac," Raney, an election worker in Texas, previously told Insider.

"This is probably how a lot of people get misdiagnosed or just don't wanna say anything about what's wrong with them, because after a while, you start thinking you're crazy," she said.

Raney was eventually diagnosed with stage 3 colon cancer, which may have been caught at a more treatable stage had her concerns been taken seriously. But she is among patients who have faced medical gaslighting, or when medical professionals dismiss a person's symptoms, making them think it's all in their heads.

It can lead to misdiagnoses, and delayed or inappropriate treatments. The experience, according to reports and research, is more common in Black people, women, and patients with obesity.

Insider talked to doctors about what to do if you think you are being medically gaslighted.

Set expectations with your provider before the visit 

Dr. Christina Johnson, a family medicine physician in New Jersey, encourages patients to set expectations before their arrival. "We wanna know: What are you hoping to accomplish? What are you concerned about? What did you Google?" she told Insider.

Let the doctor know what's your first priority, and what you'd like to cover if there's still time. And, if you've felt gaslighted in the past, say so. "That helps us better understand the urgency you feel," Johnson said. "It helps us to understand how you prefer to communicate."

Understand doctors can't perform all tests right away  

Johnson said patients sometimes expect doctors to perform advanced tests early and often. "If that was the case, we would just do full-body MRIs for everyone" who walks in the door, she said. "But we don't do that."

Rather, doctors are trained to do "if-then" thinking: "If you're experiencing this and this, then it could be this. If you're experiencing these three things, then it could be this or this or this," she said.

"It's on the clinician to communicate to the patient, 'Let's go down this route. If that route is not the case, then we'll go down this route. And if that route is not the case, we're gonna have to bring in specialist care,'" Johnson added.

Ask these questions

Johnson recommended asking the following questions if you're at an impasse with your doctor:

• What's our next step?

• If it's not this condition, what else are you thinking?

• And then, what evaluations would I need?

• Do you think I need to see a specialist?

• Have you treated people with this condition before, and if so, what was helpful for them?

She said it's also helpful to tell the clinician how your symptoms are affecting you, by saying things like:

• The pain is affecting my ability to get to work

• I'm so stiff when I wake up in the morning

Ask to work with a patient advocate

Many hospitals have patient advocates or patient navigators whose job is to guide you through the system, communicate with your providers, and sometimes even help sort out insurance issues.

"It's like getting one employee to go to bat for you, and only for you," Dr. Mikhail Varshavski, a family medicine physician known as "Dr. Mike," told Insider. "That's not utilized as often as I think it should be."

He said to ask a nurse for one, or dial zero from a hospital phone and say, "I'd like the patient advocacy office."

"Having that patient advocate with you will decrease the likelihood of communication errors and medication errors,"  Varshavski said.

Try to understand where the clinician is coming from

What patients perceive as gaslighting might really be a communication breakdown or systemic issue, Varshavski said.

"The most misunderstood point about the whole gaslighting conversation is that good providers can fall victim to this," he said.

He said rather than assuming a provider is gaslighting, say to yourself something like, "OK, I don't think I'm getting adequate care, so I'm going to assume that the reason this is happening is outside of the provider's control. But I'm still going to try and get the most out of my visit."

If your follow-up questions still fall flat, look for a second opinion. "But if both parties exhibit charitable thinking, that's where you get the best outcomes," Varshavski said.

Get a second or third opinion

Johnson said most doctors truly want to help, and if you're not finding one who gives you that sense, look elsewhere.

"There are thousands and thousands of clinicians out there who love what they do, who love helping patients, who love answering their questions and getting those diagnoses, who love helping to prevent disease, who love helping people to overcome their illnesses and get through their illnesses every day," Johnson said.

Read the original article on Insider